Flashcards in WEEk 13 Deck (54):
Reasons for NG tube insertion for decompression
- surgery or other condition may affect peristalsis...keeps stomach empty until resumes
2 most common names of tubes used for decompresion?
1) levin --> single lumen tube w holes near tip, connect to drianage bag or suction
2) Salem --> preferred for stomach decompression; has 2 lumens (one for drainage, one for an air vent
What is the purpose of the air vent in a Salem tube?
prevents suctioning of gastric mucosa into eyelets at distal tip of tube.
What to never do with air vent (blue extension) on Salem tube?
Never clamp off, connect to suction, or use for irrigation
What is the common order that a health care provider will make for gastric decompression? Why this setting/
Suction setting = "low intermittent"
This minimizes irritation to gastric mucosa
t/f sterile technique is used when inserted NG tube?
What sensation might a patient experience as the tube pases through the nasal mucosa during insertion of NG tube?
Important routine assessment for pt with NG tube in?
Supportive care provided by nurse in this regard?
Condition of the nares + mucosa for inflammation + excoriation
- Change soiled tape or fixation devices
- Keeping nares lubricated + clean
- Frequent mouth care to minimize dehydration from mouth breathing
Assessments to be completed prior to NG tube insertion?
- pt nasal + oral cavity
- ask pt if hx of nasal sx, congestion, allergies
- Not if deviated nasal septum present
- Auscultate for BS. Palpate for distension, pain, rigidity
- Pt LOC + ability to follow instructions
- Determine if pt has had previous NG tube+ which naris was used
In absence of or diminished bowel sounds, ascultate abdomen for at leas _____min(s) in each quadrant?
Why do we assess the abdomen before NG insertion?
To get baseline data
What to do if pt is confused, disoriented, or unable to follow commands when inserting NG?
Obtain assistance from another staff member to for insertion
Expected outcomes following NG decompression?
- Abdomen soft, nontender + w/o distention
- pt nares + nasal mucosa remain clear
- Pt level of comfort improves or reamins the same
What to tell pt before insertion of NG tube
May burn in nasopharynx
May cause to gag
Position for pt during NG tube insertion?
high fowler, with pillow behind shoulders + head
- place bath towel over chest
- give pt facial tissues
- allow to blow nose if needed
- place emesis basin within reach
How to prep patient nose before NG tube insertion?
wash with soap + water or alcohol swab to remove oils (so tape will adhere)
Which naris should the NG tube be inserted into? How to determine this?
What with better airflow. Get pt to occlude each one
How to determine length of tube to insert?
Measure from nose to earlobe to xiphoid process
How to decrease stiffness of tube before insertion?
What else needs to be done with tube for prep?
Take 10-15cm (4-5inches) of tube and wrap it around index finger tightly + release - this aids insertion
Lubricate 3-4inches with water soluble lube
How to position pt head for initial insertion of NG tube?
Head back (extend neck )
What to do if resistance occurs during NG tube insertion?
Apply gentle downward pressure to aid past nasopharynx
If continued resistance, try to rotate tube + see if advances
If STILL resistent, take out, allow pt to rest, lube again + try other nostril
If unable to insert tube into either naris?
Stop procedure + alert health care provider
What motion to use while inserting tube until point of nasopharynx. Then what?
- Gently rotate toward opposite naris during insertion
- Then once past nasopharynx, stop tube advancement, allow pt to relax, and provide tissues
- Explain that next step requires them to swallow. Give pt water.
- When tube just above oropharynx, instruct patient to flex head forward, take small sip of water + swallow.
- Advance tube 1-2 inches with each swallow
What do you give tissues to pt during
Tearing is normal process, as is excess salivation that may occur because of oral stimulation
If water is contraindicted in pt with NG insertion, what to do tell them to do?
Dry swallow or have suck through straw
Why do you want a flexed position for NG insertion after past oropharynx?
Closes off upper airway to trachea + opens esophagus
Swallowing closes off epiglottis over trachea + helps tube move into esophagus. Swallowing water reduces gagging + choking
What to do if pt begins to cough, gag, or choke during NG insertion?
Why might this be occuring?
Withdraw tube slightly + stop advancement. Instruct pt to breath easy + take sips of water.
Cough reflex is initiated when tube accidentially enters larynx.
What to do if vomiting occurs during NG tube insertion?
Help pt clear airway. Perform oral suctioning as needed.
(I assume you take out the tube??)
If pt is continues to gag or cough or complains that tube feels like is coiling in throat, what to do?
Check back of oropharynx with flashlight + tongue blade. Withdraw tube until tip is back in oropharynx if coiled. Reinsert w swallowing.
Where to temporarily anchor tube after NG insertion until placement is verified?
to pt cheek with piece of tape. Anchoring this way prevents accidental displacement whiel placement is verified
How to check for tube placement?
Check agency policy!!
- Ask pt to talk
- Check posterior pharynx of coiled tube
- Aspirate + see gastric content colouring
- Check pH of contents on gastric pH paper
- Obtain xray (this is the gold standard)
What colour should gastric contents be?
pH for each?
Usually grassy green, clear, and odourless.
pH = typically less than 5.0 (5.5 was said in class...)
Postpyloric tube placement appear golden yellow, yellow-brown, or greenish brown with pH greater than 6.0
Ensure gastric pH paper has range of at leasT?
1.0 to 11.0
If tube is not in stomach after initial placement, what to do?
Advance another 1-2inches + repeat all of the checks.
Where else does NG tube need to be fastened after insertion? (other than to nose)
Pin to pt gown using elastic band slip-knot + pin rubber band to gown.
How far to have HOB elevated once NG insertion complete?
30 degrees, unless health care provider orders otherwise
- helps prevent esophageal reflux + minimizes irritation of tube against posterior pharynx
Will sensation of tube in back of pt's throat subside with time?
Yes - explain this to them.
Once placement of tube is confirmed...
- Make either red mark or use tape to indicate where tube exists notes
OR measure from nare to connector - document this length in pt's record
Why should you never reposition an NG tube in a gastric surgical patient?
Positioning could rupture the suture line
What to do if NG tube not draining d/t thick secretions in narrow tube?
Irrigate tube + consult with healthcare provider for higher suction setting if unale to irrigate tube because of thick secretions
Steps for NG tube irrigation
1) HH + gloves
2) Check for tube placement in stomach. (so don't irrigate into lungs!!!!
3) Draw up 30mL NS into catheter tip syringe
4) Clamp NG tube (can place end of suction tube now disconnected on towel)
5) insert tip of syringe, remove clamp, hold syringe with tip pointed at flor + inject saline slowly (if too fast, can cause trauma)
6) After instilling, immediately aspirate slowly to withdraw fluid
7) Use asepto syringe to place 10mL of air into blue pigtail (to ensure patency of vent)
8) reconnect to suctioning
Always position air vent in Salem tube above....
The height of the stomach
Why position syringe toward floor during irrigation?
Prevents introduction of air into vent tubing which causes gastric distension.
What to do if can't irrigate?
Check for kinks
Get pt to position self onto self side
What to do prior to NG tube removal?
- Auscultate for bowerl sounds
- Explain procedure (and that it's less distressing than insertion)
Procedure for NG tube removal
1) HH + gloves
2) Turn off suction + disconnect tube
3) Insert 20mL air into lumen of NG tube
4) Remove fixation from nose
5) Hand pt facial tissue (so can blow after). Clean towel across chest, have pt take + hold breath
6) clamp or kink tubing securely + pull tube out (slowly + steadily)
7) Inspect intactness of tube
8) Note amount + character of drainage
9) Clean nares + provide mouth care
Why do we insert 20mL of air into lumen of NG tube prior to removal?
clears gastric contents to prevent aspiration or soiling of clothes
Why have pt hold breath during tube removal?
Temporary airway obstrction occurs during removal
Are pt's allowed to drink after NG tube removal?
Depends..sometimes not for 24hrs but other times fluids are allowed.
Interventions if pt's abdomen is distended and painful with NG inserted?
- assess patency of tube. NG tube may not be in stomach
- Irrigate tube
- Verify that suction is on as ordered
- Notify HC provider if distension not relieved
Pt complains of sore throat from dry, irritated mucous membranes while has NG in...what to do?
perofrm oral hygiene more frequently
ask HC provider if pt can suck on ice chips, throat losenge, or local anesthetic med
Pt develops s+s of pulmonary aspiration, fever, SOB, or pulm congestion with NG tube in. what to do/
Perform resp assessment
NOtify HC provider
Obtain CXR as ordered
What to chart after NG tube insertion?
- length, size, and type of gastric tube inserted + into which nare
- Pt tolerance of procedure
- Confirmation of tube placement
- Qualities of gastric contents
- pH value
- results from radiography
- Whether is suctioning or not + amount of suction applied
How often to record amount + characteristics of contents draining from NG tube?
Once per shift